Non-Custodial Parent Form. Last Name First Name M.I. SS# or AU Student ID#

Transcription

1 Alfred University Student (print) Non-Custodial Parent Form Student Financial Aid Office Alfred University One Saxon Drive Alfred, NY fax: Last Name First Name M.I. SS# or AU Student ID# ABOUT THIS FORM Purpose: The non-custodial parent form is used to collect information regarding the non-custodial parent s support provided to the custodial parent s household and student. The information provided is also used when determining Alfred University s need-based aid available to the student. While divorce, separation, and remarriage may affect the extent to which one or both parents can contribute to educational expenses, it does not excuse either biological parent of the responsibility. The University believes both parents, regardless of their current marital status, have a primary responsibility for contributing to their child s education and should be expected to provide reasonable financial support, based on their circumstances, before University resources are made available. Non-Custodial Parent: If a student s legal parents (biological/adoptive) are divorced, separated, or never married and not living together, the non-custodial parent is the parent with whom the student lived with less than 50% of the time during the past twelve months. Custodial Parent: The custodial parent is the student s legal parent (biological/adoptive) with whom the student lived with more than 50% of the time during the past twelve months. Who Completes This Form: The non-custodial parent should complete and submit this form to the Financial Aid Office. It should not be completed by the custodial parent on behalf of the non-custodial parent. Privacy: The information provide on this form will not be disclosed to anyone outside of the Alfred University Financial Aid Office without the non-custodial parent s written permission. If it is not possible to provide the information requested on this form, contact the Financial Aid Office to see if you are eligible to submit a waiver request. NON-CUSTODIAL PARENT INFORMATION (print) Name Address Phone: ( ) Occupation Date of separation from custodial parent Date of divorce from custodial parent Is the non-custodial parent remarried? Yes No Provide the terms of the separation and/or divorce agreement regarding educational expenses for the student? Who claimed the student as a tax dependent on the most recent tax return?

2 NON-CUSTODIAL PARENT S HOUSEHOLD MEMBER LISTING a. Provide the following information for all family members and other people who now live in the non-custodial parent s household, and will continue to live there and receive over one-half of their support from the head(s) of the household for the period July 1, 2016 to June 30, Do not include AU student. Complete college attendance only if the person will be enrolled in a program that leads to a college degree or certificate. Indicate both enrollment and student status (FT = Full-Time, PT = Part-Time, GR = Graduate Student, UG = Undergraduate Student). Part-time means at least 6 credit hours for one semester during the year College Attendance Name Age Relationship to Non-Custodial Parent Name of College Enrollment and Student Status b. Name any family member listed above who will live at home while attending college. NON-CUSTODIAL PARENT SUPPORT OF CUSTODIAL PARENT HOUSEHOLD Annual child support paid in 2015 for all children in the custodial parent s household Annual child support paid in 2015 for the student applicant When will (did) child support end? Alimony paid in 2015 to custodial parent $ NON-CUSTODIAL PARENT SUPPORT DIRECTLY TO OR ON BEHALF OF THE AU STUDENT a Tuition/Fees/Room/Board paid (to school, or student) $ b. Cash given to student $ per month c. Cell Phone Payment $ per month d. Car Payment $ per month e. Car Insurance Payment $ per month f. Car related expenses (repairs, gas, registration, inspection) $ per month g. Other financial support paid on behalf of, or to the student $ per month MONTHLY CUSTODIAL PARENT HOUSEHOLD EXPENSES PAID BY NON-CUSTODIAL PARENT a. Mortgage $ b. Car payments $ c. Rent: d. Insurance Payments $ e. Utilities f. Other (specify) $ $ 2 Student Name

3 NON-CUSTODIAL PARENT INCOME INFORMATION If currently married, the non-custodial parent s spouse s information should also be included Breakdown of Federal Tax Return Income If 2015 tax returns are not completed, provide estimates 2015 a. Wages, salaries, tips (Total of W-2 Forms-Box 5 and IRS Form 1040 Lines 12 and 18). b. Interest income (IRS Form 1040-Line 8a, 1040A-Line 8a, or 1040EZ-Line 2). c. Dividend income (IRS Form 1040-Line 9a or 1040A-Line 9a). d. Business and farm income or (loss) (IRS Form 1040-Lines 12 and 18). e1. Income or (loss) from rents, partnerships, trusts, S corporations, etc. (IRS Form 1040-Line 17). 2. Box 14 (Code A) of IRS Schedule K-1 (Form 1065). f. Other taxable income such as alimony received, capital gains or (losses), pensions, unemployment compensation, social security, etc. (IRS Form 1040-Lines 10, 11, 13, 14, 15b, 16b, 19, 20b, and 21 or 1040A-Lines 10, 11b, 12b, 13, and 14b or 1040EZ-Line 3). List the 1040/1040A line numbers, sources and amounts below Line Number & Source Amount g. IRA and self-employed SEP, SIMPLE, Keogh and other qualified plans from IRS Form 1040-total of Lines 28 and 32 or 1040A-Line 17. h. Tax-exempt interest income from IRS Form 1040-Line 8b or 1040A-Line 8b. i. Untaxed portions of IRAs and pensions from IRS Form 1040-Lines 15a minus 15b and 16a minus 16b or 1040A-Lines 11a minus 11b and 12a minus 12b. Exclude rollovers. j. Untaxed portions of health savings account from IRS Form 1040-Line 25. k. Foreign income exclusion from IRS Form 2555-Line 45 or 2555 EZ-Line 18. l. Education credits from IRS Form 1040-Line 50 or 1040A-Line 33. Non-Taxable Income Breakdown a. Payments to tax-deferred pension and savings plans (paid directly or withheld from earnings), including, but not limited to, amounts reported on W-2 Form in Boxes 12a through 12d, codes D, E, F, G, H, and S (Do not include code DD, Employer Health Insurance Contribution). b. Untaxed Social Security benefits. Report the amount received for the parents and all dependent children. Include Supplemental Security Income. Do not include any amount reported as taxable on the IRS Form Line 20b or 1040A-Line 14b. 3 Student Name

4 c. Welfare benefits, including Temporary Assistance for Needy Families (TANF). Report cash payments only. Do not report housing subsidies or food stamps. d. Annual child support amount received for all children. e. Veteran s noneducation benefits. Include Disability, Death Pension, Dependency & Indemnity Compensation (DIC), and VA Educational Work Study. f. All other non-taxable income not reported elsewhere on this form. Include untaxed pensions, unemployment, retirement, and IRA distributions not reported on the Federal Tax Return; workers compensation; disability; housing, food and living allowances paid to members of the military, clergy, and others (include cash payments and cash value of benefits). Do not include the value of on-base military housing or basic military allowance for housing. List the sources and amounts below. Source Amount NON-CUSTODIAL PARENT S AND CURRENT SPOUSE S ASSET INFORMATION a. Cash, savings, and checking accounts. b. Non-real estate investments. Include UGMA and UTMA accounts, money market funds, mutual funds, certificates of deposit, stocks, stock options, bonds, other securities, installment and land sale contracts (including mortgages held), commodities, etc. Do not include the value of life insurance, retirement plans (non-education IRAs, pension funds, annuities, Keogh plans, 401(K) plans, etc.) or prepaid tuition plans. c. Provide the value of qualified educational benefits or education savings accounts (Coverdell savings accounts, 529 college savings plan and refund value of 529 prepaid tuition plans). Otherwise, enter 0. Current Home Value Home Debt Purchase Price Year Purchased Monthly Mortgage OR Rent Business and/or Farm Value Debt $ Ownership Percentage Other Real Estate Owned. Include rental property, land, vacation homes, and second homes. Report amounts for your percentage of ownership. Do not include the non-custodial or the custodial parent s primary residence. Enter 0 if no other real estate is owned. Market Value Debt Purchase Price Year Purchased Address 4 Student Name

5 SIGNATURES AND CERTIFICATION I (We) certify that all of the information on this form and any other form submitted in application for financial aid administered by Alfred University is true and complete to the best of my (our) knowledge, and agree to provide proof, if requested by an appropriate Alfred University employee. I (We) also realize that if I (we) do not provide proof when asked, the student may be denied aid. Non-Custodial Parent s Signature Date Non-Custodial Parent Spouse s Signature Date 5 Student Name